@layout("/common/_container.html",{bg:"bg-white",js:["/assets/modular/system/ticket/ticket_add.js"]}){
<style>
    .title{
        margin-bottom: 10px;font-family: PingFangSC-Regular;font-size: 14px;color: rgba(0,0,0,0.65);line-height: 22px;
    }
    .vicInput{
        width: 472px;    border: 1px solid #D9D9D9; border-radius: 4px;
    }
</style>
<form id="userForm" lay-filter="roleForm" class="layui-form model-form">
    <input name="orderSource" id="orderSource"  type="hidden" value="1"/>

    <div style=" margin-left: 23px">
        <div class="title">
            <span style="color: red;">*</span>&nbsp;商户：
        </div>
        <div class="vicInput">
            <select name="shopId" lay-verify="required" id="shopData"  lay-search>
                <option value="">请选择商户</option>
            </select>
        </div>
    </div>

    <div style=" margin-left: 23px;margin-top: 30px;">
        <div class="title">
            <span style="color: red;">*</span>&nbsp;报事人：
        </div>
        <div class="vicInput">
            <input id="contactName" name="contactName" placeholder="请输入报事人" type="text" class="layui-input" lay-verify="required|username" required autocomplete="off"/>
        </div>
    </div>

    <div style=" margin-left: 23px;margin-top: 30px;">
        <div class="title">
            <span style="color: red;">*</span>&nbsp;手机：
        </div>
        <div class="vicInput">
            <input id="contactPhone" name="contactPhone" placeholder="请输入手机" type="text" class="layui-input" lay-verify="phone" required autocomplete="off"/>
        </div>
    </div>

    <div style=" margin-left: 23px;margin-top: 30px;">
        <div class="title">
            <span style="color: red;">*</span>&nbsp;报事内容：
        </div>
        <div class="vicInput">
            <textarea name="describes" placeholder="请输入内容" class="layui-textarea" lay-verify="required|max" required autocomplete="off"></textarea>
        </div>
    </div>


    <div class="layui-form-item text-right" style="margin-top: 30px;">
        <button class="layui-btn layui-btn-primary" type="button" ew-event="closeDialog">取消</button>
        <button class="layui-btn" lay-filter="btnSubmit" lay-submit>提交</button>
    </div>
</form>
@}
